Short-term and medium-term clinical outcomes of quinolone-resistant Campylobacter infection.

BACKGROUND: Campylobacter species is a leading cause of bacterial gastroenteritis worldwide. Quinolone resistance has emerged as an increasing problem among persons with Campylobacter infection over the past decade, but the clinical consequences are unclear. METHODS: A case-comparison study of patients infected with ciprofloxacin-resistant or ciprofloxacin-susceptible Campylobacter species was conducted in Wales during the period 2003-2004. Campylobacter isolates were classified as resistant or susceptible to ciprofloxacin on the basis of standardized disk diffusion methods. Participants were interviewed by telephone at the time of illness, 3 months later, and 6 months later to compare disease severity, duration of illness, and medium-term clinical outcomes. RESULTS: There was no difference between 145 persons with ciprofloxacin-resistant infection and 411 with ciprofloxacin-susceptible infection with regard to the severity or duration of acute illness. Mean duration of diarrhea was similar in patients with ciprofloxacin-resistant versus ciprofloxacin-susceptible infection (8.2 vs. 8.6 days; P = .57) and did not alter significantly after adjustment for potential covariates, including age, underlying disease, foreign travel, use of antidiarrheal medication, and use of antimicrobials in a multiple linear regression model. There was no difference between case patients and comparison patients in the frequency of reported symptoms or in general practitioner consultation rates at either the 3-month or the 6-month follow-up interview. CONCLUSIONS: In this study, there was no evidence of more-severe or prolonged illness in participants with quinolone-resistant Campylobacter infection, nor was there evidence of any adverse medium-term consequences. This suggests that the clinical significance of quinolone resistance in Campylobacter infection may have been overestimated.

Risk factors for ciprofloxacin-resistant Campylobacter infection in Wales.

OBJECTIVES: To identify risk factors for ciprofloxacin resistance in both travel-related and domestically acquired Campylobacter infection. METHODS: Case-comparison study of patients with ciprofloxacin-resistant and ciprofloxacin-susceptible Campylobacter infection conducted in Wales during 2003 and 2004. RESULTS: Foreign travel was the major risk factor for ciprofloxacin-resistant infection [adjusted odds ratio (adjOR) 24.0, 95% confidence interval (95% CI) 12.6-45.9]. Among travellers, case patients were five times more likely to drink still bottled water (adjOR 4.7, 95% CI 1.0-21.7), whilst among non-travellers, case patients were three times more likely to drink sparkling bottled water (adjOR 3.3, 95% CI 1.5-7.4). There was no increased risk associated with eating poultry or prior quinolone use. CONCLUSIONS: Foreign travel remains the most important risk factor for ciprofloxacin-resistant Campylobacter infection. The possible association of both domestic- and travel-related ciprofloxacin-resistant Campylobacter infection with bottled water needs to be further explored.

Sentinel surveillance for travellers' diarrhoea in primary care.

BACKGROUND: Travellers' diarrhoea is the most common health problem among international travellers and much of the burden falls on general practitioners. We assessed whether sentinel surveillance based in primary care could be used to monitor changes in the epidemiology of travellers' diarrhoea. METHODS: A sentinel surveillance scheme of 30 volunteer general practices distributed throughout Wales provides weekly reports of consultations for eight infectious diseases to the national Communicable Disease Surveillance Centre. Travellers' diarrhoea was introduced as a new reportable infection in July 2002. RESULTS: Between 1 July 2002 and 31 March 2005 there were 90 reports of travellers' diarrhoea. The mean annual consultation rate was 15.2 per 100,000 population (95% confidence interval: 12.2-18.7), with the highest rates in summer, in people aged 15-24 years, and in travellers to Southern Europe. A higher proportion of travellers than expected had visited destinations outside Europe and North America when compared to the proportion of all United Kingdom travellers visiting these destinations (38% vs. 11%; Chi2 = 53.3, p < 0.0001). CONCLUSION: Sentinel surveillance has the potential to monitor secular trends in travellers' diarrhoea and to help characterise population groups or travel destinations associated with higher risk.

Subtyping of Clostridium difficile PCR ribotype 001 by REP-PCR and PFGE.

The REP-PCR (repetitive sequence-based PCR using repetitive extragenic palindromic primers) typing method and a modified PFGE method were applied to isolates of Clostridium difficile PCR ribotype 001 with the aim of comparing their performance as methods of subtyping this organism. Of 200 isolates from 60 hospitals tested by REP-PCR, eight subtypes were identified and labelled as REP-PCR subtypes 001-008. The predominant subtype, REP-PCR subtype 003, accounted for 47% of the total. Fifty-two of the 200 isolates were analysed by a modified PFGE method and seven subtypes were identified, labelled as PF-A-PF-G. There was excellent correlation between REP-PCR subtypes and PFGE subtypes with both methods displaying broadly similar discriminatory powers. However, REP-PCR subtyping proved to be a much easier, cheaper and more rapid method suitable for application for routine subtyping of C. difficile ribotype 001. Application of REP-PCR subtyping to UK isolates of C. difficile PCR ribotype 001 from 60 different centres revealed a wide distribution of REP-PCR subtype 003 throughout England and Wales, with a regional clustering of REP-PCR subtype 001 around Northwest England and North Wales. Analysis of isolates from a single hospital over a 4-year period revealed a change in predominant subtype over time.